Hatice Gülşah KARATAŞ, Ayşegül ERTINMAZ ÖZKAN

Diyabetik Polinöropatiyi Predikte Eden Bağımsız Klinik ve Demografik Faktörler

Amaç: Diabetes Mellitus (DM) hastalarındaki diyabetik periferik polinöropatiler (DNP) yaşam kalitesini olumsuz etkileyen önemli birkomplikasyondur. İç Hastalıkları ve Fiziksel Tıp ve Rehabilitasyon (FTR) polikliniğinde DNP açısından yüksek riskli hastaları öngörmek,daha hızlı ve doğru şekilde DNP tanısı koymaya ve tanının atlanmasının önüne geçmeye yardımcı olacaktır.Gereç ve Yöntemler: Ocak 2018-Ağustos 2019 tarihleri arasında Karabük Üniversitesi Eğitim ve Araştırma Hastanesi FTR ve İçHastalıkları polikliniğine herhangi bir nedenle başvuran 173 erkek ve 226 kadın olmak üzere toplam 399 DM tanılı hasta dahil edildi.DNP tanısı LANSS ölçeği (Leeds Assessment of Neuropathic Symptoms and Signs) ile konuldu ve sonrasında hastalar polinöropatikolan (DNP+) ve olmayanlar (DNP-) olarak iki gruba ayırıldı. Gruplar arasındaki demografik veriler, VKİ (vücut kütle indeksi), HbA1cdüzeyi, DM süreleri, oral antidiyabetik (OAD) ve/veya insülin kullanımları karşılaştırıldı. DNP için bağımsız prediktörler lojistikregresyon analiziyle incelendi.Bulgular: Hastaların %38,6’sında DNP mevcuttu. Ortalama yaş, DM süresi ve VKİ DNP+ grupta DNP-’lere kıyasla anlamlı derecedeyüksekti [sırasıyla; (62.4 ± 11.1 ve 59.3 ± 12.4 ay, p = 0.014), (72.7 ± 29.9 ve 54.0 ± 26.5 ay, p < 0.001), (33.6 ± 6.3 ve 31.3 ± 6.5, p = 0.001)].DNP, HbA1c değeri >7 olanlarda ≤7 olanlara göre daha sık görülmekteydi (p=0,026). OAD, insülin kullanımları ve HbA1c düzeylerigruplar arasında benzerdi (p=0,107, p=0,075 ve 0,232). Lojistik regresyon analizinde, HbA1c düzeyi, cinsiyet ve insülin ya da oralantidiyabetik kullanımları ile DNP arasında bağımsız bir ilişki saptanmazken (P>0,05), hastalık süresinin uzun (>61 ay) olması, ileri yaş(>60,5 yaş) ve obezitenin DNP için bağımsız prediktörler oldukları saptandı [sırasıyla; Odds ratio (OR): 2,78 (%95 Güven Aralığı (CI);1,832 – 4,228, p<0.001), OR: 1,62, %95CI; 1,053 – 2,493), P=0,028 ve OR: 1,78, %95CI; 1,143 – 2,789), P=0,011)].Sonuç: DM’li hastalarda ileri yaş, beş yıldan uzun hastalık süresi ve obezitenin DNP için bağımsız klinik parametreler olduklarısaptanmıştır. Günlük pratikte DNP’yi predikte edebilen bu kriterler ucuz ve kolay uygulanabilirliği nedeniyle göz önünde tutulmalıdır

Anahtar Kelimeler:

Diyabetes Mellitus, HbA1c, obezite, polinöropati, süre

Independent Clinical and Demographic Factors Predicting Diabetic Polyneuropathy

Aim: Diabetic peripheral polyneuropathies (DPP) in patients with diabetes mellitus (DM) are important complications that adverselyaffect the quality of life. In the Internal Medicine and Physical Medicine and Rehabilitation (PMR) outpatient clinic, predicting high-riskpatients for DPP will help to diagnose it more quickly and accurately while preventing missed diagnosis.Material and Methods: A total of 399 DM patients, 173 males and 226 females, were admitted to the PMR and Internal Medicineoutpatient clinic of Karabuk University Training and Research Hospital between January 2018 and August 2019 for various reasons.The diagnosis of DPP was made using the LANSS scale (Leeds Assessment of Neuropathic Symptoms and Signs), and the patients werethen divided into two groups as polyneuropathic (DPP +) and non-polyneuropathic (DPP - ). Demographic data, BMI, HbA1c level,DM duration, oral antidiabetic (OAD) and / or insulin use were all compared between the groups. Independent predictors for DPP wereexamined by logistic regression analysis.Results: DPP was present in 38.6% of the patients. Mean age, duration of DM and BMI were significantly higher in DPP + groupcompared to DNP-[[respectively; (62.47 ± 11.17 and 59.35 ± 12.48 months, p = 0.014), (72.73 ± 29.91 and 54.04 ± 26.53 months,p<0.001), (33.69 ± 6.38 and 31.39 ± 6.52, p=0.001)]. DPP was more common in patients with a HbA1clevel of >7 than those with ≤7 (p= 0.02). OAD, insulin use and HbA1c levels were similar between the groups (p = 0.10, p = 0.07 and 0.23). In logistic regression analysis,there was no independent correlation between HbA1c level, gender, insulin or oral antidiabetic use and DPP (p>0.05), while long diseaseduration (>61 months), advanced age and obesity were found to be independent predictors of DPP [respectively; Hazard ratio (HR):2.78 (95% Confidence Interval (CI); 1.832-4.228, p<0.001), HR: 1.62, 95% Cl; 1.053-2.493), p=0.028 and HR: 1.78, 95% Cl; 1.143-2.789),p=0.011)].Conclusion: In patients with DM, elderly age, duration of the disease for more than five years and obesity were found to be independentclinical parameters for DPP. These criteria, which can predict DPP in daily practice, should be considered because of their cheapnessand easy applicability.

PDF

___

1. Eryigit Erogul, Leyla; Erogul, Ozgur. Prevalence of Diabetes Mellitus in Patients with Pterygium. Eurasian J Med Invest 2018;2(2):80-2. DOI: 10.14744/ejmi.2018.47955
2. Cho, N., et al., IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diab Res Clin Pract 2018;138:271-81.
3. Zheng, Y., S.H. Ley, and F.B. Hu, Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology 2018;14(2):88-98.
4. Tecilazich, F. and A. Veves, Role of peripheral neuropathy in the development of foot ulceration and impaired wound healing in diabetes mellitus, in Nutritional and Therapeutic Interventions for Diabetes and Metabolic Syndrome. Elsevier. 2018;p.95-104.
5. Almuhannadi, H., et al., Diabetic neuropathy and painful diabetic neuropathy: Cinderella complications in South East Asia. J Pak Med Assoc 2018;68:85-9.
6. Feldman, E.L., et al., Diabetic neuropathy. Nature Reviews Disease Primers 2019;5(1):1-18.
7. Care, D., Economic Costs of Diabetes in the US in 2017. Diabetes care, 2018;41:917-28.
8. Yagihashi, S. and H. Mizukami, Diabetic Neuropathy, in Diabetes and Aging-related Complications. Springer. 2018; p.31-43.
9. Tesfaye, S., et al., Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes care, 201033(10):2285-93.
10. Polat, M. and U.O. Akyer, Pneumonia in Patients with Diabetes Mellitus: A Single-Center Experience. EURASIAN JOURNAL OF MEDICINE AND ONCOLOGY, 2017;1(1):14-18.
11. Erbas, T., et al., Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients. Journal of Clinical Neurophysiology, 2011;28(1):51-55.
12. Ametov, A.S., et al., The sensory symptoms of diabetic polyneuropathy are improved with α-lipoic acid. Diabetes care, 2003;26(3):770-76.
13. Määttä, L.L., et al., Prospective Study of Neuropathic Symptoms Preceding Clinically Diagnosed Diabetic Polyneuropathy: ADDITION-Denmark. Diabetes care, 2019; pii: dc190869. doi: 10.2337/dc19-0869. [Epub ahead of print]
14. Gylfadottir, S.S., et al., Painful and non‐painful diabetic polyneuropathy: Clinical characteristics and diagnostic issues. Journal of Diabetes Investigation, 2019;10:1148-1157.
15. Dyck, P.J., et al., Risk factors for severity of diabetic polyneuropathy: intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort. Diabetes care, 1999;22(9):1479-1486.
16. Burns, T.M. and M.L. Mauermann, The evaluation of polyneuropathies. Neurology, 2011;76:S6-13.
17. Podwall, D. and C. Gooch, Diabetic neuropathy: clinical features, etiology, and therapy. Current neurology and neuroscience reports, 2004;4(1):55-61.
18. Sobhani, S., et al., Prevalence of diabetic peripheral neuropathy in Iran: a systematic review and meta-analysis. Journal of Diabetes & Metabolic Disorders, 2014;13(1):97. doi: 10.1186/s40200-014-0097-y.
19. Ziegler, D., et al., Treatment of symptomatic diabetic polyneuropathy with the antioxidant α‐lipoic acid: a meta‐analysis. Diabetic Medicine, 2004;21(2):114-21.
20. Satoh, J., S. Yagihashi, and T. Toyota, The possible role of tumor necrosis factor-α in diabetic polyneuropathy. Journal of Diabetes Research 2003;4(2):65-71.
21. Ziegler, D., et al., Prevalence of polyneuropathy in pre-diabetes and diabetes is associated with abdominal obesity and macroangiopathy: the MONICA/KORA Augsburg Surveys S2 and S3. Diabetes care 2008;31(3):464-69.
22. Dyck, P.J. and C. Giannini, Pathologic alterations in the diabetic neuropathies of humans: a review. Journal of Neuropathology & Experimental Neurology 1996;55(12):1181-93.
23. Yagihashi, S., Pathology and pathogenetic mechanisms of diabetic neuropathy. Diabetes/metabolism reviews 1995;11(3):193-225.
24. Karatas, F., et al., The highest (3600 IU) reported overdose of insulin glargine ever and management. Ind J Crit Care Med 2015;19:60-1.